Before the Committee on Education, the Committee on Finance and Revenue, and the Committee on Health

Council of the District of Columbia

September 27, 2017

Good morning, Councilmember Evans, Councilmember Gray, Councilmember Grosso and members of the Committees on Finance and Revenue, Health, and Education. My name is Shana Bartley, and I am acting executive director at DC Action for Children. I also serve on the State Early Childhood Development Coordinating Council (SECDCC).

DC Action provides data analysis and policy leadership on critical issues facing DC children and youth. We are the home of DC KIDS COUNT, an online resource that tracks key indicators of child well-being in the District.

I am here today to testify on both the Infant and Toddler Developmental Health Services Act of 2017 and the Bolstering Early Growth Investment (BEGIn) Amendment Act of 2017. At DC Action, we believe that investing in our youngest residents is key to securing the future of our city. We are grateful to join our partners on the Birth-to-Three Policy Alliance and the DC Home Visiting Council to speak on these important and timely bills. For the 43,000 DC children under 5 to succeed, especially the 23% living in families below the poverty level, we must create a system that ensures that our youngest children have access to quality and comprehensive services. [1][2]

The early childhood landscape is vast: it spans six DC agencies that oversee and administer programs and services for young children and their families, and includes hundreds of providers. We commend the District agencies for their efforts to focus on quality and systems-building. DC is one of nine BUILD states striving to develop a comprehensive early childhood system; a team of agency leaders assembled by OSSE has worked together since 2014 to increase collaboration and coordination within the landscape.[3] The Quality Improvement Network (QIN) Interagency Steering Committee brings the six agencies together monthly; the BUILD Initiative provides additional ongoing support and technical assistance as the group continues their efforts. DC Action serves as the systems evaluator for the QIN and attends many of these meetings. We know there is a great deal of energy and momentum to construct a strong system.

Based on our experience working within the landscape, we wrote a white paper, Piecing Together: Completing the Early Childhood System Puzzle in the District. We released the paper earlier this week in which we highlight that the District currently has many of the critical pieces needed to build an effective, coordinated early childhood system. This paper provides important context and tangible recommendations for building the infrastructure necessary to support quality service delivery to young children and their families.[4] DC’s early childhood stakeholders have long recognized that we have not been able to achieve a well-coordinated system. Given the recent administrative and legislative efforts in early childhood, we have an opportunity to create a coordinated, comprehensive system – one that prioritizes families’ needs, uses resources wisely, promotes racial equity and sets young children up to succeed.

We applaud the Council’s efforts to encourage coordination and create alignment within the early childhood landscape through these two bills. I offer DC Action’s comments on the bills individually; however, I encourage the Council to combine these bills where appropriate to ensure efficient implementation and to support coordination within the system. Since these two bills address many of the same issues, this will be helpful as we think about next steps. Furthermore, I ask that the Council also examine how these bills and other legislation focusing on early childhood can work together to move the system forward. DC Action is happy to serve as a resource in this effort to consolidate language and ensure that the resulting legislation creates efficiency, sustainability and better coordination.

Comments on the Infant and Toddler Developmental Health Services Act of 2017:

DC Action would like to thank Councilmember Gray for working to improve the lives of our children in Wards 7 & 8. The Infant and Toddler Developmental Health Services Act is an ambitious bill that highlights the importance of deepening connections among maternal and child health, early learning and family support services. There a couple of areas that we would like to address.

A needs assessment should guide expansion of home visiting.

As a member of the DC Home Visiting Council (HV Council), DC Action for Children is supportive of efforts to expand the reach of home visiting services to families who would most benefit. Early childhood home visiting is a family support strategy that provides education, parenting techniques and resources to families with young children. In these evidence-based programs, trained home visitors work collaboratively with families who are expecting or who already have young children to achieve improved outcomes in school readiness, child welfare, and/or child health and development. The HV Council works to strengthen the infrastructure for and the implementation of home visiting services throughout the District. The HV Council – which is comprised of home visiting providers, advocates, local government agencies and managed care organizations, among others - approaches this work by promoting best practices, planning and coordinating program support, and conducting strategic research and advocacy for home visiting.

We are glad that this bill seeks to expand the target populations for home visiting. We know from our work with home visiting providers that the demand for these services exists: programs report that their home visitors have full caseloads and many report having waitlists. However, we believe home visiting is one valuable family support that should function within a system of other early childhood services. Therefore, as we expand home visiting services, we must be precise in identifying the families who should be targeted to make the greatest gains. It is not clear that home visiting is the appropriate intervention for the families identified in this bill (“families with children under 3 in in-home CFSA placements”).

We recommend conducting a home visiting needs assessment informed by the DC Home Visiting Council. This assessment would identify target populations for whom home visiting is likely the best option, quantify the need for expansion, and connect home visiting with other services within the early childhood system. The DC Home Visiting Council could provide expertise and support in the development and completion of this assessment. District home visiting services should then be targeted based on the findings of such a study.

A strategically-placed early childhood integrated data system is essential.

DC Action views Help Me Grow DC – which provides outreach, screening and referrals to services for families – as an asset to the District’s early childhood system. Help Me Grow provides an essential service to pregnant women and families of young children: the ability to easily access the support they need. It also provides the opportunity to better understand the ways in which the District is equipped to serve families, information that could be used to strengthen an early childhood system. In reviewing this bill, we noted that DOH currently implements many of the provisions addressing Help Me Grow. We support the program’s continued expansion and we commend the Department of Health’s work to date.

This bill would require Help Me Grow to develop a new data system and begin collecting and reporting on additional data such as outcomes or program participation data. We recognize the need for more coordinated and centralized tracking of early childhood data and we applaud this bill’s effort to provide such a mechanism. However, given the goals of Help Me Grow, the current configuration of the District’s early childhood data and the desire for a well-placed early childhood integrated data system, we do not believe the Help Me Grow data system should be modified to incorporate data outside the scope of the program’s design.

Help Me Grow, as designed, collects developmental and maternal depression screening data that is used to make referrals to appropriate services equipped to conduct more in-depth assessment and diagnosis. As a screening, referral and surveillance program, Help Me Grow does not collect outcomes or program participation data. Rather, outcomes data is tracked by systems outside the Department of Health, including the Student Longitudinal Data System (SLED), which is managed by OSSE.

DC Action agrees that collecting more integrated data is an important element of a strong early childhood system. However, we believe that identifying a home for this data should be a strategic and thoughtful process that results in a system such as an early childhood integrated data system. In developing this system, we recommend looking to the work that has already been done locally – such as that at SECDCC – and coordinating development of an integrated data system with input from early childhood stakeholders. We would strongly support this effort and would be glad to discuss it with you further.

Comments on the Bolstering Early Growth Investment Amendment Act of 2017:

We are thankful for Councilmember Robert White’s thoughtfulness as the Bolstering Early Growth Investment Amendment Act of 2017 recognizes the need for integration across the early childhood landscape. We are pleased to see that several pieces of this proposed legislation aim to reduce siloes and streamline processes across many of the agencies that serve DC’s youngest residents. This bill covers a variety of areas in early learning; we will focus on a few of those here.

Based on implementation of the Shared Services Alliance, OSSE should expand shared services to child development centers and CBOs.

We support the bill’s proposed expansion of shared services to include child development centers and CBOs. Shared services programs are designed to share the burden of business, financial, and workforce administrative tasks place on providers, granting them extra time to dedicate in the classroom and participate in professional development. Thus, these models can contribute to increased quality of services and improved outcomes for children. The Office of the State Superintendent for Education (OSSE) has already put the Shared Services Alliance for child development homes in motion, and we hope lessons from implementation of this program will inform the expansion to other providers.

DC Action agrees that it is important to streamline cross-agency processes for providers; however, creating an Office of Early Childhood Development within OSSE may lead to duplication of efforts and other navigation challenges. We encourage OSSE, DCRA and other necessary agencies to engage providers and work together to develop a cross-agency structure that is more efficient and provider-friendly.

Align subsidy reimbursement rates with the cost of care.

According to OSSE’s 2016 cost model study, providers face a deficit of $1,000 - $2,000 dollars per child when accepting a subsidy rate.[5] We are glad to see that both the BEGIn Act and the Infant and Toddler Act seek to address this challenge. We ask the Council to align subsidy reimbursement rates with the cost of care. In order to make progress towards closing this gap, we recommend that the Council make a strong commitment in the Fiscal Year 2019 budget by including a down payment towards aligning the subsidy rate with cost of care.

As the Council approaches its work to integrate systems, streamline processes for providers and families and increase quality so that young children in the District achieve positive outcomes, we encourage the Council to use data to inform its legislation. We are pleased to see that the BEGIn bill includes mechanisms that are place-based and that seek to target areas of the highest need. We encourage the Council to continue to approach questions about resource distribution by utilizing accurate and timely data segmented on a variety of levels, including by race/ethnicity, income, and ward and neighborhood cluster.

We are grateful for the Council’s consistent dedication to reducing disparities and ensuring that our youngest residents are set up to thrive in school and in life. We know that no one action or initiative alone can remedy inequities. We encourage the District to think critically about the steps necessary to establish a coordinated, well-financed system of support for young children that spans early learning, health and family support. Thank you again for the opportunity to testify. I am happy to answer any questions you may have.

Key Recommendations:

Conduct a needs assessment for home visiting informed by the DC Home Visiting Council.

Develop a design and implementation plan for an early childhood integrated data system.